Human dissection and attitudes of preclinical students to death and bereavement

Abstract

Two questionnaires were used to gather information about preclinical education concerning death and bereavement. One was mailed to Heads of Anatomy Departments of 26 UK medical schools. The other was distributed to 220 first-and 210 second-year preclinical students in Cambridge. Among curricular organizers (77% response rate), the motivation for giving such education was primarily to improve knowledge about dissection, and only secondarily and infrequently to prepare students for clinical practice or to address their attitudes or feelings. In contrast, the primary concern of students (response rate 54%) was preparation for encounters with death in clinical practice (61-85%), lesser concerns being to address their own fears and feelings (30-40%) or knowledge about the dissecting room, cadavers, etc. (23-37%). Students were also asked about their reactions to dissection in order to determine whether the dissecting room might provide an opportunity for teaching about death. Most (66%) admitted experiencing moderate to extreme apprehension in advance of dissection. Apprehension was associated, on starting dissection, with very strong reactions, which in some cases interfered with learning. Some (27%) dealt with this by depersonalization. The only previous experiences that showed a significant association with the occurrence during dissection of interfering andlor non-task-related thoughts and feelings were (i) for both men and women the occurrence and quality of handling of death experience(s) at school, and (ii) for a group of male students the experience of the death of more than one close non-family friend. A strategy for effective use of the dissecting room in studies on death is outlined.

Human gross anatomy: A crucial time to encourage respect and compassion in students

“…T h e anatomy laboratory is an appropriate place to introduce such discussions for several important reasons. First, students taking anatomy are beginning their medical education and are highly impressionable (Hull, 1991;Gustavson, 1988;Segal, 1987;Druce and Johnson, 1994). Second, many students admit that they have disturbing psychological and physical reactions during the course of dissection (Horne et al, 1990;Finkelstein and Mathers, 1990;Druce and Johnson, 1994;Penney, 1985).…”

“…It is our experience, and that of others (Druce and Johnson, 1994;Penney, 1985;Wear, 1989), that students often want to know this information. Instructors can cooperate by allowing access to the death records, provided these are not confidential.…”

“…Human gross anatomy is a course that has profound effects upon students. A large number of studies report that students of human dissection often exhibit a variety of psychological and physical disturbances engendered by this unusual experience: apprehension, anxiety, nausea, intrusive visual images, nightmares, insomnia, learning impairments, and preoccupation with death (Penney, 1985;Gustavson, 1988;Marks, 1985, 1989;Horne et al, 1990;Finkelstein and Mathers, 1990;Druce and Johnson, 1994). T h e more severe of these disturbances resemble typical symptoms of persons suffering from post-traumatic stress disorder (Finkelstein and Mathers, 1990).…”

“…Therefore, it is not surprising that students consistently express a need for more adequate psychological and emotional support during the laboratory course in human dissection (Penney, 1985;Druce and Johnson, 1994). As instructors, we can show students respect and compassion by acknowledging this need.…”

Services of thanksgiving at the end of gross anatomy courses: A unique task for anatomists?

“…T he anatomist plays a critical role in the initiation of a balanced attitude to death and dying in the training of medical students (Druce and Johnson, 1994;Nnodim, 1996;Marks et al, 1997). In the course of medical education, anatomists are the earliest to be confronted with problems such as death anxiety of students (Dickinson et al, 1997).…”